2024
Medical Devices Applying for Outpatient Medicare Supplemental Payments
Moneer O, Johnston J, Rathi V, Ross J, Dhruva S. Medical Devices Applying for Outpatient Medicare Supplemental Payments. JAMA Health Forum 2024, 5: e244016. PMID: 39546305, PMCID: PMC11568453, DOI: 10.1001/jamahealthforum.2024.4016.Peer-Reviewed Original ResearchMeSH KeywordsAmbulatory CareCenters for Medicare and Medicaid Services, U.S.Cross-Sectional StudiesDevice ApprovalEquipment and SuppliesHumansMedicareOutpatientsProspective Payment SystemReimbursement MechanismsUnited StatesUnited States Food and Drug AdministrationConceptsCenters for Medicare & Medicaid ServicesMedicare beneficiariesUS Centers for Medicare & Medicaid ServicesCross-sectional studyCross-sectional analysisPatient demographic characteristicsClinical decision-makingMedicaid ServicesMain OutcomesHispanic patientsClinical evidence requirementsPremarket clinical studyOutpatient settingOutpatient paymentsTraditional pathwaysMedicareSupplemental paymentsFiscal yearTransitional pass-through paymentsReimbursementDemographic dataEffectiveness end pointPathway applicationClinical studiesAuthorization pathways
2021
Medicare’s New Device-Coverage Pathway — Breakthrough or Breakdown?
Rathi VK, Johnston JL, Ross JS, Dhruva SS. Medicare’s New Device-Coverage Pathway — Breakthrough or Breakdown? New England Journal Of Medicine 2021, 384: e43. PMID: 33691059, DOI: 10.1056/nejmp2101874.Commentaries, Editorials and LettersCenters for Medicare and Medicaid Services, U.S.Device ApprovalEquipment and SuppliesGovernment RegulationInsurance CoverageMedicareUnited StatesUnited States Food and Drug Administration
2018
Coverage of Novel Therapeutic Agents by Medicare Prescription Drug Plans Following FDA Approval
Shaw DL, Dhruva SS, Ross JS. Coverage of Novel Therapeutic Agents by Medicare Prescription Drug Plans Following FDA Approval. Journal Of Managed Care & Specialty Pharmacy 2018, 24: 10.18553/jmcp.2018.24.12.1230. PMID: 30479199, PMCID: PMC10397592, DOI: 10.18553/jmcp.2018.24.12.1230.Peer-Reviewed Original ResearchMeSH KeywordsCenters for Medicare and Medicaid Services, U.S.Cross-Sectional StudiesDrug ApprovalInsurance CoverageMedicare Part DOrphan Drug ProductionPrescription DrugsPrior AuthorizationTime FactorsUnited StatesUnited States Food and Drug AdministrationConceptsNovel therapeutic agentsPrescription drug plansOrphan drug statusFDA approvalYear of approvalTherapeutic agentsNovel therapeuticsPrior authorizationNovel therapiesPriority reviewStep therapyMedicare prescription drug plansDrug plansDrug coverageNational InstituteDrug statusPart D prescription drug benefitMedicaid ServicesDrug characteristicsTherapeutic areasCross-sectional studyDrug benefit coverageHealth insurance payerBlue Cross Blue Shield AssociationPrescription drug benefitState-Level Population Estimates of Individuals Subject to and Not Meeting Proposed Medicaid Work Requirements.
Silvestri DM, Holland ML, Ross JS. State-Level Population Estimates of Individuals Subject to and Not Meeting Proposed Medicaid Work Requirements. JAMA Internal Medicine 2018, 178: 1552-1555. PMID: 30208409, PMCID: PMC6248197, DOI: 10.1001/jamainternmed.2018.4196.Peer-Reviewed Original ResearchCenters for Medicare and Medicaid Services, U.S.Cross-Sectional StudiesEligibility DeterminationHumansMedicaidUnited StatesEvidence supporting FDA approval and CMS national coverage determinations for novel medical products, 2005 through 2016
Roginiel AC, Dhruva SS, Ross JS. Evidence supporting FDA approval and CMS national coverage determinations for novel medical products, 2005 through 2016. Medicine 2018, 97: e12715. PMID: 30290675, PMCID: PMC6200488, DOI: 10.1097/md.0000000000012715.Peer-Reviewed Original ResearchMeSH KeywordsAgedCenters for Medicare and Medicaid Services, U.S.Clinical Trials as TopicCross-Sectional StudiesDouble-Blind MethodDrug ApprovalHumansInsurance CoverageMiddle AgedUnited StatesUnited States Food and Drug AdministrationConceptsOriginal clinical trialsCMS national coverage determinationsNational Coverage DeterminationClinical trialsFDA approvalControl armFDA approval documentsQuality of trialsCross-sectional studySignificant differencesCoverage determinationMedian ageMedian timePivotal trialsQuantity of evidenceInclusion criteriaTrial participantsMedicare populationCMS coverageDrug AdministrationStudy sizeNovel therapeuticsMedicaid ServicesMarketing approvalTrials
2016
Accounting For Patients’ Socioeconomic Status Does Not Change Hospital Readmission Rates
Bernheim SM, Parzynski CS, Horwitz L, Lin Z, Araas MJ, Ross JS, Drye EE, Suter LG, Normand SL, Krumholz HM. Accounting For Patients’ Socioeconomic Status Does Not Change Hospital Readmission Rates. Health Affairs 2016, 35: 1461-1470. PMID: 27503972, PMCID: PMC7664840, DOI: 10.1377/hlthaff.2015.0394.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.Databases, FactualFemaleHealth ExpendituresHospitals, RuralHospitals, UrbanHumansInsurance CoverageMalePatient DischargePatient ReadmissionRetrospective StudiesSocioeconomic FactorsUnited StatesConceptsHospital Readmissions Reduction ProgramPatients' socioeconomic statusMedicare's Hospital Readmissions Reduction ProgramLow socioeconomic statusReadmission ratesSocioeconomic statusRisk-standardized readmission ratesHospital readmission ratesReadmissions Reduction ProgramMedicaid Services methodologyReadmission measuresHospital resultsPatientsHospitalSuch hospitalsPayment penaltiesReduction programsStatusCurrent CentersLower proportionLarge proportionPercentAdjustmentProportionDeclining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time
Dharmarajan K, Qin L, Lin Z, Horwitz LI, Ross JS, Drye EE, Keshawarz A, Altaf F, Normand SL, Krumholz HM, Bernheim SM. Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Health Affairs 2016, 35: 1294-1302. PMID: 27385247, DOI: 10.1377/hlthaff.2015.1614.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.Chronic DiseaseDatabases, FactualDisease ProgressionFemaleGeriatric AssessmentHospital MortalityHumansIncidenceLength of StayMaleOutcome Assessment, Health CarePatient AdmissionPatient ReadmissionRetrospective StudiesRisk AssessmentSeverity of Illness IndexTime FactorsUnited StatesFinancial Ties Between Emergency Physicians and Industry: Insights From Open Payments Data
Fleischman W, Ross JS, Melnick ER, Newman DH, Venkatesh AK. Financial Ties Between Emergency Physicians and Industry: Insights From Open Payments Data. Annals Of Emergency Medicine 2016, 68: 153-158.e4. PMID: 26973175, DOI: 10.1016/j.annemergmed.2016.01.014.Peer-Reviewed Original Research
2009
Reduction in Acute Myocardial Infarction Mortality in the United States: Risk-Standardized Mortality Rates From 1995-2006
Krumholz HM, Wang Y, Chen J, Drye EE, Spertus JA, Ross JS, Curtis JP, Nallamothu BK, Lichtman JH, Havranek EP, Masoudi FA, Radford MJ, Han LF, Rapp MT, Straube BM, Normand SL. Reduction in Acute Myocardial Infarction Mortality in the United States: Risk-Standardized Mortality Rates From 1995-2006. JAMA 2009, 302: 767-773. PMID: 19690309, PMCID: PMC3349070, DOI: 10.1001/jama.2009.1178.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.FemaleHospital MortalityHumansLength of StayMaleMyocardial InfarctionRiskUnited StatesConceptsRisk-standardized mortality ratesAcute myocardial infarctionShort-term mortality rateMortality rateHospital variationNonfederal acute care hospitalsAcute myocardial infarction mortalityHospital mortality rateDay of admissionRisk standardized mortality ratesAcute care hospitalsMyocardial infarction mortalityHealth care professionalsIndex hospitalizationCare hospitalMyocardial infarctionNational averagePatient levelMedicare patientsObservational studyMedical adviceHospital varianceMAIN OUTCOMECare professionalsPatients